Healthcare Provider Details

I. General information

NPI: 1083307441
Provider Name (Legal Business Name): LAUREN LUCAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 S MCHENRY AVE
CRYSTAL LAKE IL
60014-7444
US

IV. Provider business mailing address

781 S MCHENRY AVE
CRYSTAL LAKE IL
60014-7444
US

V. Phone/Fax

Practice location:
  • Phone: 815-459-2200
  • Fax:
Mailing address:
  • Phone: 815-459-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036181184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: